Generally, urinary incontinence is defined as involuntary, spontaneous urination resulting from pressure in the bladder exceeding the resistance provided by weak bladder and sphincter muscle contraction. Urinary incontinence can be a serious problem to social activity and hygiene.
Urinary incontinence may be classified as urge incontinence, stress incontinence, or mixed stress and urge incontinence.
Urge incontinence is involuntary urination resulting from weak or unstable urinary muscles which are insufficient to block the flow of urine when the urge to urinate arises.
Stress incontinence is defined as urination of less than 50 ml when stressful activity that abruptly increases pressure in the abdomen is performed, due to laxity in the urethral ligament, bulbocavernous, perineal, and anal sphincter muscles. The stressful activity may include various activities such as coughing, sneezing, laughing, weight-lifting, running, nose-blowing, intensive exercise, impatience, excitement, stair climbing, abruptly standing-up, and so on.
Mixed stress and urge incontinence results from combination of pressure to the abdomen and laxity of the urinary muscles.
Generally, women are more prone to urinary incontinence than men. Therefore, in today's society, where the participation of women in public affairs and the proportion of senior citizens in the population have abruptly increased, mental, social, and economic damage resulting from urinary incontinence can be very serious. First, with regard to economic damage, a report published in the United States in 1989 reads that the cost of managing urinary incontinence is more than 10 billion US dollars, which is more than is spent on treating AIDS patients.
In addition, urinary incontinence causes the vulva to be always wet, which can lead to skin problems and infection. Further, anxiety, tension, and embarrassment due to odor complicate personal relationships and social activity, which can hurt self-confidence, give a sense of alienation, and even lead to psychological disorders such as depression.
Moreover, excessive expansion of the pelvis during pregnancy and delivery weakens the pelvic muscles (or vaginal muscles) and causes urinary incontinence as well as sexual dysfunction. In a survey, 90% of respondents reported that they have avoided sex at least one time because of urinary incontinence. In particular, 80% of female respondents with serious incontinence avoided sex at all times. Urinary incontinence is a serious condition making it difficult to carry on a sexual relationship as well as causing inconvenience in daily living.
An examination for urinary incontinence may include, for example, a medical examination by interview, a question paper, a uroflowmetric test, a residual urine examination, a urodynamic examination, a crystoscopic examination, X-ray and ultrasonic examination, keeping a urination diary, feminine pad examination, application of a perineometer, and so on. The perineometer is classified as a manual (pump) type or an electronic type. Hospital and university research centers mainly use perineometers to measure pressure and duration of contraction of the pelvic floor muscles in order to evaluate urinary incontinence and the effects of exercise for enhancing the pelvic floor muscles (Kegel exercise). However, since the examination device such as the perineometer is specialized equipment, it is very difficult for a patient to use personally.
Medical treatment of urinary incontinence may include, for example, medicinal therapy, surgical operation, and non-surgical operation.
Medicinal therapy uses medicines such as anticholingeric, a smooth muscle relaxant, tricyclic antidepressant (TCA), and so on. Surgery may include, for example, a sling operation, a Birch's operation, a tension free vaginal tape (TVT) operation, a collagen injection operation, a balloon dilatation operation, and so on.
Non-surgical operation may be classified as either physical therapy or behavior therapy. The physical therapy may include, for example, transcutaneous electrical nerve stimulation (TENS), magnetic field treatment, vaginal cone treatment, thermotherapy, magnetic treatment, feedback using the perineometer, and so on.
TENS is a method of enhancing passive muscle power by applying electric stimulus to the pelvic floor muscles, and magnetic field treatment is a method of passively contracting the pelvic floor muscles using a magnetic field.
The behavior therapy may include, for example, bladder training, Kegel exercise, bio-feedback, and so on.
Bladder training is a method of training the body to urinate at certain times, and Kegel exercise, contrived by Arnold Kegel in 1948, is a widely used method of enhancing the functionality and strength of the pelvic floor muscles by periodically contracting the muscles. Since the pelvic floor muscles (vaginal muscles) are not usually used, it is important to exercise an isolated part of the pelvic floor muscles. However, when the pelvic floor muscles are exercised, the abdominal muscles and the hip muscles are also used, thereby increasing pressure in the abdomen which may aggravate urinary incontinence.
Bio-feedback is a tool for performing physiological self-adjustment, a type of behavior treatment based on the theory of “learning through reinforcement” proposed by B. F. Skinner. A bio-feedback apparatus detects the biological reaction of a patient and converts it into a visible, audible, and/or otherwise sensible signal such that the patient can then see, hear, and/or sense the signal to assist in self-treatment.